I’m struck by the fact that people with addiction issues, when confronted with the destructive effects of their behaviors, often find it harder to stop. This is especially true, in my clinical experience, when it comes to compulsive sexual behavior, aka sex addiction. Why is that?

Therapy clients who struggle with drinking or substance abuse tend on the whole to accept – eventually, and with my ongoing support – that they do have a problem with drinking or using, and that these behaviors are an obstacle to happier living. Once “the cat is out of the bag”, they usually attempt to reduce or quit using, over time, or else quit therapy altogether.

Those struggling with compulsive sexual behaviors, however, may remain ambivalent for years, while remaining in therapy –  aware of their dependence on these behaviors and the destructive effects of same, while wrestling with whether or not they want to stop. It’s a matter of two steps forward, two steps back, over and over again, with no change in sight.

Additionally, it is often reported to me that there appear to be more people in Alcoholics Anonymous with long-term sobriety compared to those in Sex Addicts Anonymous or Sex and Love Addicts Anonymous or other 12-step programs for healthier sexuality. Those with long-term sexual sobriety – or “abstinence” – tend to be fewer in number. Again – how come?

I know there is a lot of controversy in the mental health field about whether sexual compulsivity is truly an “addiction.” It is not my intent here to address that complex question. Suffice it to say that the suffering of those who can’t stop, in the face of heartbreaking damage and loss, is staggering to behold. If one of the key criteria for an addiction is an inability to stop in spite of negative consequences, then compulsive sexual behavior more than qualifies as an addiction.

So, if one assumes we are in fact dealing with two actual addictions, we are still left with the aforementioned disparity between drug/alcohol vs. sexual sobriety. Is it because one can live without drugs or alcohol, but cannot “remove” sexuality from one’s being? We are, organically speaking, sexual creatures, and the goal of treating sexual addiction is not to remove one’s sexuality but to create healthier, more intimate and less self-destructive behaviors.

I suspect that, because we are dealing with sex after all, the issue goes even deeper. Sexual desires and fantasies often emanate from the very core and are difficult to interpret. Heterosexual men with compulsive sexual issues, for instance, may desire sex with other men while staying married to a woman; some pursue sex with transvestite prostitutes, in ways that put themselves at legal and medical risk. I know of high-functioning women who are compelled to conduct serial affairs, virtual or real, with men whose only apparent goal is to sexually “use” them in sadistic or degrading ways. These are people who have little to gain, it would seem, and everything to lose.

Another complication is that sexuality is a relational activity. It always implies another person, either real or fantasized. One can use heroin or drink alone, as many do. But it always “takes two to tango”, even if one of those people is a fantasy or “virtual” person. Even when one uses online pornography, for instance, another person is “present”, at least onscreen.

Close readings of sexual fantasies and compulsive behaviors can be revealing of one’s buried self-concepts and unexpressed needs; an S&M fantasy may represent a way of coping with an overbearing or shame-inducing caregiver, by sexualizing the pain and staying in control of the fantasy/scenario (even if one is the “M”). Those struggling with scenarios of dominance over others may be trying to compensate for intolerably low self-worth, an attempt to control chaotic emotions leftover from a traumatic upbringing.

My experience with straight men who compulsively watch porn often reveals a desire for a woman who can offer everything but demand nothing, and disappear when the encounter is over, before she decides he’s “too much” for her, or “gross,” or perverted, etc.  It’s a sort of mini-relationship, easily controlled by someone who usually has a desire for and deep fear of intimacy, who gets his needs met quickly and then signs off.

It’s almost as if these fantasies provide a window into the psyche, revealing unmet needs.   Like the need to feel in control, to express repressed desires, to sexualize (i.e. numb or self-medicate) hurtful or shameful feelings or other emotions that are unconscious or too difficult to articulate.

These are feelings and needs that cannot be expressed in their actual relationships – usually because they are perceived as “disgusting” or “too much” for their partner.  Of course, their partner very often has her own “stuff” and tends to be closed off, angry, controlling, etc.  It’s an extremely painful dynamic that I see with many of my male clients – straight and gay – who struggle with sexual compulsivity.

Why would a man, or anyone really, seek an “emotionally unavailable” partner? Because we tend to gravitate toward the familiar, even if what is familiar is dissatisfying or even abusive.

Very often the person chooses an emotionally closed off, or overly aggressive (or withdrawn) partner because, in reality, the alternative is too scary. It may sound strange, but what’s even scarier than not finding love – especially in cases of a traumatized upbringing, which includes just about everyone I work with – is actually finding it! Why is that? Because love can be lost or taken away, leaving the person abandoned and traumatized (again) – even more painful than being mistreated or ignored. In the latter case, at least you know someone is there.

Thus the person suffering from core interpersonal trauma – the result of a faulty caregiver, another human being – who ends up sexualizing their needs via the behaviors described above, hovers between a desperate yearning for and deep aversion to intimate connection. The sort of “mini-relationship” described above is often a substitute. It satisfies…for a while. One connects, finds relief via sex and affection (what’s actually virtual feels real at the moment) – then detaches before becoming too invested or emotionally “at risk” for abandonment.

That emotional risk, believe it or not, is usually more frightening than the prospect of the legal or health risks that accompany these behaviors. Abuse and emotional distance is familiar, even if painful, while the possibility of genuine love is new and terrifying.

Thus the compulsive behaviors are a temporary solution to the very real and shameful problem of a confusing inability to connect with others.  I say “shameful” because very often the feeling is something like, “I’m an idiot because I don’t know how to stop.  Why do I do such disgusting things.  What a piece of garbage I truly am.”  (Even if the person is outwardly successful, wealthy, etc.  As they say in recovery, it’s always an inside job.)

One of my clients once said in my office, with a smile on his face, “I have no love in my life.  I’d only ruin it if I did”.  This was a successful, married attorney with a compulsion to see prostitutes.

It took me a few moments to realize the smile was an awkward attempt to conceal shame, not any sort of bemusement. That smile was one of the saddest things I’ve ever seen.

What I want to stress here is the pain that needs soothing is, in part, not the result of an unrequited hunger for love, nor a fear of finding it, but rather an impossible non-reconciliation between the two.

Here are two opposing, powerful forces at work, with radically different agendas – one to connect, the other to protect.  Without help, this internal conflict results in unmanageable emotional turmoil and frustration. The cycle never ends, until the person says “enough,” and seeks help.

I’ll talk next time about how therapy can, when effective, provide a slow but steady path towards healthier intimacy and a chance to escape the suffocating shame and loneliness that so many of my clients describe as a slow-moving poison — leading them to behaviors they so desperately want to stop, but can’t.

Related Articles:
Super-sizing Sex
The Good and Bad Sides of Porn
Three Ways to Avoid Sex Addiction Relapse

Repressive coping is a strategy of self-protection that involves dismissing or ignoring strong emotions. People who use repression as a means of coping often do so out of self-defense and tend to experience the same negative emotional symptoms as those who struggle with anxiety. In a new study, Marcus Mund, of the Friedrich Schiller University in Germany, sought to determine if repressive coping also led to the development of physical symptoms associated with anxiety, such as hypertension, asthma, cardiovascular disease and cancer. “If repressive copers repressed unwanted feelings permanently, and if repression of feelings was associated with the mentioned physiological features, it is close at hand to infer that a high proportion of repressors should be affected by pathologically high blood pressure or associated diseases like coronary heart disease (CHD). Indeed, there are numerous studies linking both and showing serologically an increased risk for severe cardiovascular diseases (CVD),” said Mund. “Additionally, repressive coping is assumed to be associated with the development of cancer.” He added, “The same is true for asthma and diabetes, which both can be linked to several immune features.”

Mund and his colleagues analyzed data from over 6,700 clients. They found that those who repressed their feelings were 31% more likely to be diagnosed with diabetes, CVD, hypertension, asthma or cancer. With respect to cancer, those who used repression coping were 51% more likely to be diagnosed with the illness than those who did not. However, Mund said, “For cancer, the present results imply that repressive coping does not precede the diagnosis, but is rather a consequence of it.” He added, “Concerning CVD, the meta-analysis showed that repressors’ risk of suffering from at least elevated blood pressure is increased by 80% compared to non-repressors.” Mund believes the heightened state of arousal that repressors experience causes an increase in cortisol, which directly affects blood pressure and indirectly affects other somatic symptoms. “The current meta-analysis revealed significant associations between repressive coping, cancer, and cardiovascular diseases, especially hypertension,” said Mund. “These results add to the notion of repressive coping as a consequence of cancer as well as to its important role for the issue of hypertension.”

Reference:
Mund, M., & Mitte, K. (2011, November 14). The Costs of Repression: A Meta-Analysis on the Relation Between Repressive Coping and Somatic Diseases. Health Psychology. Advance online publication. doi: 10.1037/a0026257

Failure is a part of life. How an individual perceives their failure gives an indication of their overall sense of well-being and adjustment. Reflecting on past failures through imagery can provide even further detail into the one’s coping strategies. “As people recall and imagine life events, they often form mental images of those events and may do so from different visual perspectives,” said Lisa K. Libby of the Department of Psychology at Ohio State University. “With the first-person perspective, one sees the event from their own vantage point, as an actor in the scene; with the third-person perspective, one sees the event from an external vantage point, watching the self. This subtle phenomenological variable can have powerful effects on responses to pictured events, influencing judgment, emotion, and behavior.” Libby was interested to see if this shift in perspective was influenced by self-esteem, or if self-esteem played a role in how perspective affected one’s perception of failure. “One of the most well documented differences between low- and high-self-esteem individuals (LSEs and HSEs) is in how they react to failure: LSEs have more extreme negative reactions,” said Libby. “In particular, LSEs are prone to overgeneralize, a response style that is characterized by ‘a tendency to bring thoughts of personal inadequacy to mind and/or experience a reduction in the sense of self-worth.’”

Libby and her colleagues enrolled 83 undergraduate students in their study. The students were instructed to recall a failure they had experienced or to imagine one, from whichever perspective came naturally. The results revealed that LSE’s overgeneralized when they viewed their failures from the third-person. “In contrast, no such effects of self-esteem emerged when individuals pictured failure from the first-person perspective.” Libby added, “Further, among LSEs, picturing failure from the third-person, as opposed to first-person, perspective produced greater negativity in accessible self-knowledge and greater shame. Among HSEs, no such detrimental effects of third person imagery occurred—only beneficial effects.” Libby believes these results have important implications for understanding how clients cope with failure in their lives.

Reference:
Libby, L. K., Valenti, G., Pfent, A., & Eibach, R. P. (2011, November 7). Seeing Failure in Your Life: Imagery Perspective Determines Whether Self-Esteem Shapes Reactions to Recalled and Imagined Failure. Journal of Personality and Social Psychology. Advance online publication. doi: 10.1037/a0026105

Sharing emotional experiences, or engaging in emotional disclosure, can be a cathartic process, resulting in reductions in stress, anxiety and tension. “In an opposite manner, the active concealment of distressing information is associated with psychological distress and physical symptoms such as headaches and backaches,” said Angela M. Garrison of the Department of Counselor Education and Counselor Psychology at Western Michigan University. Similarly, people with depression or anxiety often suppress their emotions to avoid facing negative feelings. Research has shown that individuals who have attachment issues struggle with emotional disclosure as well. Because emotional disclosure is so closely linked to depression and attachment, it is difficult to determine how each condition affects emotional regulation. “Specifically, depression symptoms and attachment are both associated with emotional disclosure, but depression symptoms and attachment are also related to each other,” said Garrison, lead author of a recent study on emotional disclosure. “For theory clarification, it is therefore important to disentangle the effect of depression symptoms on emotional disclosure from the potential effects of attachment on emotional disclosure.”

In order to isolate the effects, Garrison and her colleagues assessed 121 college students for depression and attachment problems, as well as emotional disclosure using a daily diary for seven days. “Results indicated that depression symptoms were negatively related to generalized disclosure tendencies and to intra-individual daily intensity-disclosure slopes,” said Garrison. “Attachment avoidance was negatively related to both generalized disclosure tendencies and to daily disclosure, and attachment anxiety moderated the relation between daily event intensity and disclosure.” She believes clinicians should be aware that a depressed client may need encouragement to disclose particularly difficult emotions. “Knowing this may enable clinicians to encourage these clients to talk about their emotions even when their initial reaction is to not share their feelings.” She added, “It may also be important for clinicians to encourage disclosure differently in clients who are avoidantly or anxiously attached given that recent research has supported the notion that attachment orientation does impact clients’ levels and patterns of disclosure in psychotherapy.”

Reference:
Garrison, A. M., Kahn, J. H., Sauer, E. M., & Florczak, M. A. (2011, November 7). Disentangling the Effects of Depression Symptoms and Adult Attachment on Emotional Disclosure. Journal of Counseling Psychology. Advance online publication. doi: 10.1037/a0026132

“Like father, like son.”

“Like mother, like daughter.”

These sentiments are often expressed with great joy and pride. Many parents are delighted and honored when their children seek to emulate them. As children grow older and think about what they want to be when they grow up, some choose to be in the same occupation as the parent.

When children opt for the same work roles as their parents, they may have the advantage of a role model who can show them the ropes, provide connections for school or jobs, and set the stage for what it is like to be in the parent’s job. Often, sharing the same job with a parent can increase the attachment between parent and child and make the relationship closer. Sometimes, though, when parent and child have differing ideas about how the work role should be performed or conceptualized,  conflicts might undermine the relationship. Under these circumstances, it may be difficult for the parent to accept that, while their child is drawn to the parent’s work, they have their own ideas about how that work should be done.

Alan and His Father

Alan came to see me about the conflict he was experiencing working in his father’s business, a chain of sporting goods stores. At the time he sought therapy, he had been working for his father for five months. It was especially important to Alan that I understood that he felt like he was working for, not with, his father. He admitted that he was surprised how much he liked the work. It was a fun environment to work in and he could even envision himself taking over the store someday. But he was concerned that he would never be given enough authority or autonomy to  feel like he could implement his ideas. For now, he didn’t feel he could really make the business into his vision of what he wanted it to be. His father had a completely different way of thinking about the stores.

Growing up, Alan had loved going to work with his father. He would help his father stock the shelves and talk about the latest equipment. They would go over every detail of the most recent sports game they had watched together; they were both intense fans of the same teams and this helped to create a profound bond between them.

But as Alan and I talked, some of the underlying issues connected to his conflict about continuing to work for his father began to emerge. Alan began to realize how difficult it was for him to let his father know that he wanted something that was different from what his father wished for. He recalled that, growing up, he didn’t like to get into arguments with his father, so he either just went along or never voiced his own wishes if he thought they would result in conflict.

He remembered how, on the rare occasions that he had tried to assert his own desires against his father’s ideas, his father had become very cold toward him. In middle school he became interested in hard rock music and wanted to learn to play the guitar. His father derided the music as having no value and refused to buy the instrument or pay for lessons. It wasn’t until Alan stopped expressing his wish to learn to play the music that his father resumed his friendly, jovial relationship with him.

After high school graduation, Alan went to an out-of-state college to study business administration. His parents were very supportive and paid his tuition and board. Overall, Alan described his home life as satisfying. Toward the end of Alan’s college, his father began to ask him about his future plans. Although one of Alan’s professors was encouraging him to apply to a company he had some connections with, Alan’s dad began to push his idea that Alan could put his business skills to good use in the sporting goods business. He invited Alan to come and work for him.

Alan’s first thought was, “How am I going to be able to tell him that I don’t want to do this?” Feeling anxious, Alan told his father he would think about it. But his father kept trying to convince him, and Alan began to waiver. Feeling pressured and worried about his relationship with his father, Alan’s agreed to give the sporting goods business a try for a year and then decide if he wanted to stay on or get into the corporate world.

Alan Learns to Assert His Ideas

I asked Alan when the last time was that he and his father had a disagreement, other than this recent conflict about his work. Alan told me that he couldn’t think of one. After their differences about music, Alan didn’t engage his father when they were in disagreement, so Alan’s father didn’t know that Alan had different points of view. Now, Alan believed his father thought that everything was okay and assumed that Alan would stay on in the business even though the agreement was to see what happened after one year.

When Alan realized that it had been a very long time since he tried to assert his own desires against his father’s wishes, he wondered if it was worth a try to speak with his father and address his concerns about his role in the business. He was anxious about how his father would respond to his need to have more authority and to be a partner, not an employee. He worried that if he brought it up, his father would become cold and rejecting as he had in the past. In spite of his worry, Alan decided to risk his father’s reaction. He hoped that if he could convey how much he shared his father’s love for the store, perhaps their differing ideas about the business would be more acceptable.

All Alan wanted was for his father to be able to listen and take his thoughts seriously. He told me, “I have to remember that I’m not eleven years old anymore. If my father gets cold and rejecting, I don’t have to give up what I want to please him. I know that he still loves me. I have to remind myself that I am not doing anything bad to him by being different.”

Self-Assertion is Not an Attack

Alan’s realization captures what a child needs to come to understand about their self-assertion: it is not bad to assert one’s unique, separate self to a parent. While a parent may feel hurt or disrespected, those are feelings, not facts. The child’s challenge is to tolerate the parent’s feeling by being respectful, understanding, and empathic. The child should recognize, “I understand that my parent feels like my differing ideas are an attack on him, but I know that is not how I feel. They are just my ideas.”

Some parents can find it in themselves to understand that their child’s difference from them is not a statement that there is something wrong with the parent. Rather, the child has developed into a separate person who may disagree with the parent. Hopefully, they can both respect the other person’s thoughts and feelings. Unfortunately, there are some parents who find it impossible to consider a child’s individuated, separate self as anything but an attack on their own way of seeing the world. In such cases, there may be nothing a child can do but understand that this is just how the parent feels, and that they can’t take responsibility for the parent’s wounded feelings.

Alan did speak with his father. After much discussion, he was able to help his father understand how he felt when his father treated him like an employee. He began to understand Alan’s wish to work with him, not for him. Alan and his father continue to talk about their work relationship and Alan is much less afraid to speak his mind. He is much happier at work and with himself. It is a work in progress.

If Hollywood is an indicator of our most common fantasies, modern Americans want to sleep with their therapists. I am horrified that so many television shows and movies depict romantic relationships between therapists and clients as though they were perfectly normal! The truth is, romance within a therapeutic relationship is as far from normal, acceptable, healthy, and sane as you can possibly get.

The writers of How I Met Your Mother currently have the character Robin dating her previous therapist. The relationship has been rationalized through a series of cutesy excuses: “Well, we only had a handful of therapy sessions … it hardly counted!” and, “Well, if we have a session where the previous client now becomes the therapist, it will all balance out!” ICK!  In no way, shape, or form is dating a current or previous therapist healthy, ethical, or socially acceptable.

In California, there is a legal clause that states that a personal relationship between a previous therapist and client may be pursued two years after the termination of services. However, research tells us that the power imbalance remains strong, even after time has passed, and that romance in this situation is usually still emotionally damaging to the one who was the client. Hormones, brain chemistry, and emotional issues often inadvertently conspire to lead us toward unhealthy romantic choices, which is why therapists are clearly instructed that “Professional Therapy Never Includes Sex” (this is the name of a pamphlet that every single therapist-in-training in California receives on several occasions). Although specifics vary from state to state, 19 states have sexual exploitation laws forbidding therapists from engaging in sexual contact with clients.

Even though in the movie 50/50, Joseph Gordon-Levitt appears to find care, comfort, and I-don’t-know-what-else in the arms of his intern therapist (I don’t know because I walked out of the movie), your therapist is neither your caretaker nor your best friend. Your therapist can help you develop the skills you need to go out and make friends and find someone to help you through the difficulties of life. But if your therapist tries to convince you that his or her role is to love and protect you, run away! That is NOT appropriate therapy! And if he or she makes any sexually suggestive advances (verbal or physical), you know you are not working with an ethical therapist.

Extensive worldwide research and anecdotal evidence dating back to the origins of formalized therapy indicate that romantic relationships between therapists and their clients, regardless of which role is the initiator, are criminally damaging to the client in the majority of situations. The client is typically left with extreme emotional disruption, feelings of emptiness, isolation and guilt, and a tragically impaired ability to trust.

Certainly the therapeutic relationship is a unique situation wherein two human beings share space in a room while playing particular roles that ask them to maintain strict discipline of their human instincts, but to share the greatest level of openness and honesty imaginable. When deconstructed, the therapeutic hour shows itself to be a very bizarre social construct that is quite challenging to enact in a productive and healthy way. When properly delivered, the benefits of appropriate psychotherapy can be powerfully life-changing. However, there are many ways to get off track throughout the process, which is why therapists need to be well-trained, licensed, ethically and emotionally stable, grounded in common sense, and masters of self-discipline and self-care.

The boundaries around the therapeutic relationship are essential to the success and integrity of our profession, and I find it inexcusable for our entertainment industry to treat the subject matter so lightly and irresponsibly. We know that the mass public derives their sense of “normal” and desirable from the information presented on the screens in front of them. If this were an isolated incident of poor judgment, I could write it off as such. But the theme has become so ubiquitous as to appear in highly rated productions reaching tens of millions impressionable minds worldwide.

I started enjoying the recently cancelled sitcom, Free Agents, until the female character’s therapist asked her out during a session and they started dating. What? After a few therapy sessions, in which he did nothing of therapeutic value, he declared her problem-free and decided to hit on her. My concern is that the writers of these shows may actually be typical, regular people who truly believe that relationships with therapists are normal. If this storyline is depicted in other regular people’s everyday media consumption, a very serious misconception about the purpose and practice of psychotherapy may occur.

Of course, romantic, sexual, and loving feelings can arise between two people who sit close together and speak of personal and intimate issues on a regular basis. A well-trained and ethical therapist will seek professional consultation if romantic or lustful feelings arise and will follow wise counsel as to the most ethical way to proceed. Often these feelings can be worked through and resolved without any negative effect on the therapy. If the feelings persist, the responsible and legitimate therapist will control his or her impulses and refer the client to another professional. With the help of an esteemed consultant, they can determine how best to implement the transition with the client.

The therapist portrayed by Gabriel Byrne in In Treatment struggled with sexual feelings toward a client in the first season of the series. I have not seen these episodes, but I know the series is highly revered and often seen by the general public as an accurate representation of therapy. It was very disheartening for me to hear that this character acted on his sexual impulses, even though he apparently understood the harm that physical intimacy could do to his client. I think these representations are misguided and ill-advised, as they imply that the psychotherapeutic setting is always imbued with sexual energy and tension.

It is not uncommon for strong feelings to arise in a psychotherapy client. For many schools of thought, this is actually an important part of the therapeutic process. However, if the feelings become strong enough to breach the integrity of the therapy, they must be addressed. In the healthiest of situations, the client would admit these feelings to the therapist—the best therapeutic alliances are built on trust and acceptance, communicating to the client that no judgment or disgust will befall them in that room, under any circumstances. If a client shares the feelings he or she is having, the issue can be discussed openly and often can be resolved, bringing greater insight and personal power to the client. If the feelings cannot be redirected and resolved, it is best to help the client find a new therapist to continue the growth work in a nonsexualized setting.

Looking at current blog posts, I see many people justifying their seductions, romances, and friendships with their therapists. Most of these bloggers are writing at the beginning of their relationships and seem not to believe that they may not get a Hollywood ending. I am very concerned that media representations of our profession are casting a skewed and uninformed light on this very complex issue. The general public is clearly buying into the idea that dating their therapists may be legitimate.

Perhaps we therapists can take this challenge as an opportunity for greater enlightenment and education with our clients. It will keep us on our toes (even more) so that we may identify and address misplaced emotional feelings that arise in therapy. This aspect of the profession is difficult enough without added pressures from the mass media. However, our awareness of the issue can serve to reinforce our ethical stance and prepare us for any type of challenge that may walk through our consultation door.

Many couples I work with come in with a large amount of stress and difficulty. The causes vary, but the behaviors people use to respond to the upset are often predictable. People who start out loving each other sometimes find themselves so burdened by stress and difficulty that they end up feeling frustrated in the relationship.

Research suggests that up to a third of married individuals report low marital satisfaction, and approximately 20% of all married couples experience marital distress at any given time. These numbers reflect what therapists see daily in their practices.

No one starts out being frustrated. Frustration comes after being unhappy, sometimes for a long time. Often, couples with the best intentions end up not being able to explain themselves to each other, or they won’t say what they really want to say, and as a result they feel tense, stressed and oftentimes frustrated.

The most frequent problem reported by unhappy couples is poor communication. Frustration can appear in many ways. It may come out as a curt answer to a question. Maybe it’s a rolling of the eyes, or a “whatever” response to a partner, or no response at all. Frustration can also be felt when one person ignores the other altogether.

Sometimes frustration is a slammed door, or a sigh. It’s a sign of exasperation from the frustrated person to the other telling them something is very wrong. It also broadcasts unhappiness and discontent. And it’s a problem. It keeps the frustrated person trapped in difficulty and leaves the other partner in the dark regarding the source of the problem.

What would be helpful is to discover how to talk about what doesn’t feel good in the relationship. Unfortunately, this is often difficult for couples who have not communicated with each other for a while. Over time, the breakdown in communication evolves into increased arguing, stonewalling, defensiveness, and contempt. Distressed couples tend to engage in these negative patterns of communication often and are unable to successfully repair the relationship after an argument.

If you find yourself answering your mate with frustrated gestures, you might want to think about what is happening to you. I am pretty sure you used to have very soft, loving responses in the early days. Maybe as time passed you found yourself unable to express your thoughts and feelings to your partner without worrying how he or she might react. It’s possible you may even have started keeping your thoughts and feelings to yourself, not wanting to bother your mate. But the more you kept your thoughts and feelings inside without speaking them, the more you might have felt yourself becoming stressed and uncomfortable.

This is the body’s natural response to too much tension. Marital stress can alter endocrine, cardiovascular, and immune function—key pathways from troubled relationships to poor health. This tension is a clear message about what it feels like when you can’t express yourself and you keep your feelings inside. You might have a sensation of all your feelings being trapped inside your own body and you can’t let them out, like you are frozen. You keep yourself suppressed and you suffer. At first you might be able to manage your increased stress. Maybe you exercise more or take up an activity. Maybe you yell at the kids instead or a co-worker. Perhaps you overindulge; too much alcohol, drugs, or food.

The more you figure out how to manage your challenges, the more you might be looking at your partner with disdain. You may start to believe that he or she just doesn’t care about what you think and feel. Individual and couple responses vary greatly; That’s when people start with the one word answers, or the disinterest, or the shaking of the head. These behaviors tell the other person you are not interested in them. These reactions indicate that you are unhappy.

If you are unhappy in your relationship, take stock of how you are feeling right now. Ask yourself, “Am I stressed and unable to talk to my partner about what is bothering me?” If you answer yes, start looking at the ways you do talk to your mate. Are you short and abrasive? Do you dismiss him or her? Do you just not bother because you don’t think anything will change?

If you answered yes to any of these questions, you

So how do you change your situation? You just took the first step; you recognized it. From here you might want to talk to someone: a friend, family member, religious mentor, or counselor. Get your long held feelings from inside yourself outside of your head by communicating them. Try to understand what is preventing you from talking to your mate about these feelings. Learn why you stay silent.

There are effective treatments for marital distress. No one begins as a perfect partner and a successful marriage depends on a number of skills, such as the ability to understand one’s own behavior and motives, to understand one’s partner, to argue and problem-solve productively, and to effectively negotiate differences—all of which can be enhanced by working with a marriage and family therapist.

You will likely feel better even after just a few sessions. You could also learn different ways to communicate your feelings that may give you confidence. When you leave your old behaviors – the eye rolling, sarcastic responses, non answers – and replace them with true expressions of your feelings, a number of things might also happen. Your stress and tension may decrease, and it’s possible you might even begin to experience some happiness, and that might feel pretty great.

When to Seek Professional Help

Over 98 percent of clients of marriage and family therapists report therapy services as good or excellent. After receiving treatment, almost 90% of clients report an improvement in their emotional health, and nearly two-thirds report an improvement in their overall physical health. A majority of clients report an improvement in their functioning at work, and over three-fourths of those receiving marital/couples or family therapy report an improvement in the couple relationship.

If you’re experiencing persistent relationship frustration, consider reaching out to a qualified couples therapist or marriage and family therapist. They can help you and your partner develop better communication skills and work through underlying issues contributing to your frustration.

For immediate support, you can:

Contact the Find a therapist directory

Call the SAMHSA National Helpline: 1-800-662-4357 for mental health resources

Reach out to your healthcare provider for referrals

References:

1. Regan, P., Walsh, S., Horton, R., Rodriguez, G., & Kaufman, L. (2025). Contextualizing marital dissatisfaction: Examining profiles of discordant spouses across life domains. Frontiers in Psychology, Collection date 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC11961942/
2. Association for Behavioral and Cognitive Therapies. (2021). Marital distress fact sheet. https://www.abct.org/fact-sheets/marital-distress/
3. American Association for Marriage and Family Therapy. (n.d.). Marital distress. https://www.aamft.org/AAMFT/Consumer_Updates/Marital_Distress.aspx
4. Heim, C., & Heim, C. (2025). How long-term couples cope with chronic stressors and adverse life course events in marriage: A qualitative study. The American Journal of Family Therapy, Published online: 18 Feb 2025. https://www.tandfonline.com/doi/full/10.1080/01926187.2025.2459688
5. Shrout, M. R. (2021). The health consequences of stress in couples: A review and new integrated Dyadic Biobehavioral Stress Model. PMC, PMC8474672. https://pmc.ncbi.nlm.nih.gov/articles/PMC8474672/
6. American Association for Marriage and Family Therapy. (n.d.). About marriage and family therapists. https://www.aamft.org/AAMFT/About_AAMFT/About_Marriage_and_Family_Therapists.aspx

According to Randy P. Auerbach of Harvard Medical School, McLean Hospital, positive feelings and feelings of happiness are the result of intrinsic pursuits. “Intrinsically-motivated goals are thought to be inherently interesting, pleasurable, and/or meaningful,” said Auerbach. “In contrast, extrinsically-motivated goals are typically sought in order to attain a reward (i.e., material goods or money) or to avoid punishment.” Research has shown that pursuing both intrinsic and extrinsic goals can be beneficial, but not when one is at the expense of the other. Auerbach said, “Guided by self-determination theory, the research posits that the neglect of intrinsic goals ultimately thwarts the satisfaction of core, inherent psychological needs for relatedness, competence and autonomy, which in turn contributes to negative psychological outcomes including depressive symptoms.” Additionally, people who value extrinsic goals over intrinsic goals may neglect their interpersonal relationships and exert all of their time and energy in the pursuit of material objects and money. Another concern is that children whose parents value extrinsic goals above intrinsic ones may not foster sufficient interpersonal skills in their children, creating maladaptive relationship models for them as adults.

To test how the prioritization of values affected the psychological well-being of adolescents from various cultures, Auerbach and his colleagues studied over 600 teens from Canada and China. They found that the teens with the highest motivation toward extrinsic goals had elevated levels of interpersonal stress. “Further, consistent with past research examining the relationship between stress generation and prospective depressive symptoms, dependent interpersonal stress predicted higher levels of depressive symptoms over time.” The team added, “In conclusion, the present study highlights the relationship between aspirations, stress, and depressive symptoms in culturally distinct samples of adolescents. Traditional prevention and treatment programs primarily target cognitive and interpersonal vulnerability factors. However, the findings in the present study suggest that clinicians must also understand a patient’s core values as they may play an important role in shaping stress generation and subsequent symptoms.”

Reference:
Auerbach, Randy P., Christian A. Webb, Meghan Schreck, Chad M. McWhinnie, Moon-Ho Ringo Ho, Xiongzhao Zhu, and Shuqiao Yao. “ExaMining the PathWay through Which Intrinsic and Extrinsic Aspirations Generate Stress and Subsequent Depressive SyMptoMs.” Journal of Social and Clinical Psychology 30.8 (2011): 856-86. Print.

There are many ways one parent can influence how children perceive their other parent. This is often a positive experience for children, as they learn to appreciate both of their parents as individuals. Other times—especially during a divorce—this is a negative experience, making it difficult for children to manage their feelings of loyalty and have loving relationships with both parents.

It is sometimes the case that one parent is truly a danger and should not have access to the children as determined by a court of law. However, alienating behaviors often occur not because of fear of danger to children, but because of conflict between parents due to hurt feelings, imagined offenses, actual offenses, infidelities, feelings of abandonment, and more. There are various levels of alienating behaviors, all of which impact children, but some of these behaviors are more damaging than others.

Sometimes one parent might say something negative to other other parent in front of the children. Usually, they will quickly regret the statement and will try to mitigate the inappropriateness in an effort to minimize damage to the child and their relationship to the other parent. When a child already has a difficult relationship with the other parent, this effort to talk to the child about it is very important.
Behaviors can step up from there, from parents who, while they might regret their outbursts, do not believe it is their job to make sure there is a good relationship between the children and the other parent; to parents who are determined that there is no relationship possible. Parents may see this as a battle, thinking they are protecting their children, when in fact children tend to be the “casualties of war” between the warring parties.

Here are some examples of alienating behaviors, from more benign to more egregious:

• When it is time for children to go to the other parent and they refuse to go, the delivering parent does not encourage them to go to the other parent, stating they do not want to force them to go against their will.
• When one parent calls to talk to the children, the parent who answers stages a loud conversation about responsibilities for financial difficulties, while the children wait to “have to” get on the phone.
• Unwillingness of one parent to attend events where the other parent will be in attendance, letting the children know their unwillingness and the reasons for it.
• Letting the children know that he or she will feel badly if the child goes to the other parent when he or she feels ill, there is a relative visiting from out of town, etc.
• Telling the children he or she does not want to hear about what they do when they are with the other parent.
• Ripping up photographs or letters from the other parent with no regard for children’s awareness of the activity.
• Telling the children information about the other parent, such as issues regarding finances or infidelities—sometimes admitting that they should not have said anything.
• Telling lies about the other parent, like “Your father had an affair” or “Your mother is an alcoholic” when statements cannot be supported with evidence.
• Telling the children they can’t repeat things to the other parent about who they spend time with, how they’re doing in school, trips they have taken, or other information.
• Threatening to stop loving the children if they continue to have a relationship with the offending parent.
• Creating an environment that is so toxic to the children that they find it easier to believe the lies and innuendos and choose one parent to align with—usually the parent exhibiting the alienating behaviors, effectively ending the relationship with the other parent.

This is clearly not an exhaustive list. Hopefully, you will not find yourself represented in any of them.

Every so often I will be treating a couple, one of whom says that the other doesn’t care about religion or spiritual matters. The complainant may cite a lack of support for his or her spiritual or religious activities. Sometimes the partner resents the time devoted to religious/spiritual pursuits.  Sometimes one or the other person feels alone when it comes to events that are more couple or family oriented (such as holiday celebrations). In my religion, the Yoruba/Lucumi faith, the activities, initiations, drumming, etc. are so labor-intensive, it is hard to imagine being with someone who isn’t in some way in the faith.

When working with these couples, I explore if there is really some other issue lurking beneath the surface of the presenting complaint. Sometimes there is something not readily apparent; for example, feelings of neglect in general, sexual problems, addictions, abuse, and so on. Ultimately, these “hidden” are the issues that must be worked on in the treatment.

However, if most of the relationship is working well and this is the real complaint, I tend to explore the feelings on both sides rather than the issue of why someone is or isn’t religious/spiritual. The feelings that typically surface are those of abandonment: sometimes there is a feeling of scorn and contempt on the part of the religious/spiritual one, loneliness on both sides, a lack of joint purpose/values/goals, or a drastically different world view and outlook on life, just to cite a few examples.

I also explore why it is so difficult for one or the other to allow the partner to be on his or her own path. Is perhaps this some form of codependence that requires homogeneity in thought and belief? Is it perhaps threatening to one or the other to be different? Are there fears that unless the two are the same, they can’t survive as a couple?

While it is important in a relationship to have shared interests and values and to some extent goals, each person in a couple does not have to be a carbon copy of the other. After all, it is different points of view that make a relationship interesting.

As long as the other person is not critical, contemptuous or belligerent as far as the other’s religious/spiritual beliefs, it is important for each person in the couple to follow his or her heart when it comes to religion and spirituality. Too many people have been pressured by parents, extended families, social groups, communities and other such entities to follow along with a certain religious/spiritual example. Ideally, this is one area where there should be freedom of choice (even though that is often not the case). So, to perpetuate that lack of choice in a relationship makes it even worse for both parties.

I do appreciate that the issue becomes more complex when it comes to raising children. If this hasn’t been discussed prior to making a commitment to the other, then it needs to be worked out with mutual respect. Often compromise is the only way to resolve something like a conflict in this area, knowing full well that the children will probably decide what they want to do in the long run anyway.

Ultimately, what couples should strive to avoid is using religion/spirituality as a tool for manipulation of one another. That goes against the very purpose of belief, and in the long run is divisive and destructive to the relationship. Respecting another’s differences is really the only choice to make.

Related Articles:
Five Domains of a Healthy Relationship
What is “This”? An Exercise in Contemplation
Appropriate Conversations about Spirituality in Counseling

“Gay and bisexual men experience numerous negative health conditions, including high rates of mental health problems,” said Beth N. Fischgrund of the Department of Psychiatry & Behavioral Sciences at Northwestern University, and lead author of a new study examining masculinity and mental health in gay and bisexual men. “Empirical studies show that a strong adherence to masculine norms is correlated with poor health outcomes, such as mental health problems and risky sexual behaviors.” National studies have shown that gay men are nearly twice as likely to suffer from depression and anxiety as heterosexual men, and that suicide rates for these men are nearly double those of other men.

The way gay and bisexual men perceive their masculinity has a significant impact on mental health. “Society’s messages about sexuality are not the only cultural attitudes that sexual minority men are confronted with; cultural attitudes also delineate what it means to be a man,” said Fischgrund. She added that some men may exhibit hyper-masculine behaviors when they feel their masculinity is being threatened. “Gay men who endorse hyper-masculine norms might then experience identity incongruence when they are presented with general society’s norms that differ and contradict their own. In these situations, the more integral the hyper-masculine norms are to a man’s identity, the more psychological distress he may experience.”

For her study, Fischgrund recruited 311 gay and bisexual men, nearly a third of which reported an HIV positive status. “Among these gay and bisexual men, those who adhered to norms that incorporate an interpersonal aspect of masculinity (i.e., conceptions of masculinity as social behavior or as sexual  behavior) endorsed higher levels of mental health distress than did men who adhered to norms that focus on the intrapersonal aspects of masculinity (i.e., conceptions of masculinity as physical appearance),” said Fischgrund. “Additionally, men who did not know their HIV status endorsed higher levels of depression.” She emphasized the importance of her findings. “Specifically, designing programs that center on altering the social and sexual masculine norms within the gay male community are needed to decrease the mental health burden of gay and bisexual men, which has been shown to be associated with HIV risky behaviors.”

Reference:
Fischgrund, B. N., Halkitis, P. N., & Carroll, R. A. (2011, October 24). Conceptions of Hypermasculinity and Mental Health States in Gay and Bisexual Men. Psychology of Men & Masculinity. Advance online publication. doi: 10.1037/a0024836

Shyness is a behavior that can cause problems for children and adults. But adolescents, who experience elevated emotional turmoil, are more vulnerable to the symptoms of extreme shyness. “Although they might be easy to overlook, they probably experience much private unhappiness, as adolescent shy behavior is linked to loneliness, having fewer friends, and other internalizing problems such as anxiety, low self-worth, depression, social phobia, and eating disorders among women,” said Neira van Zalk of the Center for Developmental Research at Orebro University in Sweden. Shyness has also been shown to cause stress in social situations, leading to social anxiety that can result in negative thoughts, impaired job performance and general dysfunction. These symptoms can be caused by a number of factors, but recently, researchers have begun to examine how parenting styles influence the development of shyness in children. “As a number of reviews show, different forms of socially fearful behaviors, such as shyness, behavioral inhibition, social anxiety, social withdrawal, and reticence, are associated in young children with two forms of parental psychological control: intrusive control and criticism or rejection,” said van Zalk. Parents who are over-controlling, although their intentions are good, may shield their children from stressful life situations, thus prohibiting their ability to develop coping skills and self-regulation. Another factor linked to childhood shyness is the amount of warmth exhibited by parents. Studies suggest that children who receive praise and warmth experience less anxiety, stress and loneliness than children who receive little parental warmth.

Van Zalk and a team of researchers analyzed data collected from several waves of a larger study conducted on Swedish adolescents. The teens were interviewed for symptoms of anxiety and shyness, and reported how they perceived the parenting they received. “In this study,” said van Zalk, “We found that the more shy adolescents were, the more intrusively controlling, rejecting, and less emotionally warm they perceived their parents to be over time. There was also some evidence that the more youths perceived parents as intrusively controlling, the more their shyness increased over time.” Van Zalk added that the teens with the most severe shyness received the least parental warmth. “Why would shyness elicit these behaviors from parents? One possible explanation is that parents mistakenly see the adolescent’s social isolation as intentional and that they tend to do this more as youths age,” said van Zalk. “Their lack of warmth and rejection might reflect frustration or concern that is not expressed properly. Another possibility is that some correlate of shyness helps to explain parents’ critical, rejecting reactions.” Van Zalk added, “Maybe parents whose children show shy behavior can help by being aware of their children’s oversensitivity and their own responses to their children.”

Reference:
Van Zalk, Nejra, and Margaret Kerr. “Shy Adolescents’ Perceptions of Parents’ Psychological Control and Emotional Warmth: Examining Bidirectional Links.” Merill-Palmer Quarterly 57.4 (2011): 375-401. Print.